Barriers to Implementation of Breast Cancer Risk Assessment: The Health Care Team Perspective

Breast Cancer Screening in the Intermediate-Risk Population: Falling Through the Cracks?

Breast cancer screening guidelines vary for women at intermediate risk (15%-20% lifetime risk) for developing breast cancer across jurisdictions. Currently available risk assessment models have differing strengths and weaknesses, creating difficulty and ambiguity in selecting the most appropriate model to utilize. Clarifying which model to utilize in individual circumstances may help determine the best screening guidelines to use for each individual.

Implementation of risk assessment process for breast cancer risk in primary care

Background

Current cancer prevention guidelines recommend assessing breast cancer risk using validated risk calculators such as Tyrer-Cuzick and assessing genetic testing eligibility with NCCN. Women at high-risk of breast cancer may be recommended to undergo additional or earlier screening. Risk assessment is not consistently implemented in the primary care setting resulting in increased morbidity and mortality in unidentified high-risk individuals.

Methods

A single-arm interventional study was conducted in an academic primary care clinic for women 25-50 years old presenting for primary care appointments. Pre-visit workflows evaluated breast cancer risk using the Cancer Risk Assessment (CRA) Tool and information was provided to the clinician with guideline-based recommendations. Post-visit questionnaires and chart review were conducted.

Results

The survey response rate was 24.5% (144/587) with 80.3% of responses completed online (94/117). The average age of respondents was 35.8 years with 50.4% White and 35.9% Black. There were no differences in response rate based on race. Risk discussion was documented in the medical record in 15.4% of cases with a higher rate of documentation in high-risk patient based on risk assessment as compared with average risk respondents (34.6% vs. 9.7%, p<0.01). In the high-risk women identified 11.4% (4/35) were seen by the high-risk breast clinic, and 5.7% (2/35) were referred for genetic evaluation. None had previously obtained MRI screening or genetic testing.

Conclusions

There is limited identification and evaluation of women at high risk for breast cancer. Pre-visit surveys can be used as a tool to assess breast cancer risk in the primary care setting; however additional strategies are needed to implement systematic risk assessment and facilitate appropriate treatment based on risk level.

Factors influencing U.S. women's interest and preferences for breast cancer risk communication: a cross-sectional study from a large tertiary care breast imaging center

BACKGROUND

Breast imaging clinics in the United States (U.S.) are increasingly implementing breast cancer risk assessment (BCRA) to align with evolving guideline recommendations but with limited uptake of risk-reduction care. Effectively communicating risk information to women is central to implementation efforts, but remains understudied in the U.S. This study aims to characterize, and identify factors associated with women's interest in and preferences for breast cancer risk communication.

METHODS

This is a cross-sectional survey study of U.S. women presenting for a mammogram between January and March of 2021 at a large, tertiary breast imaging clinic. Survey items assessed women's interest in knowing their risk and preferences for risk communication if considered to be at high risk in hypothetical situations. Multivariable logistic regression modeling assessed factors associated with women's interest in knowing their personal risk and preferences for details around exact risk estimates.

RESULTS

Among 1119 women, 72.7% were interested in knowing their breast cancer risk. If at high risk, 77% preferred to receive their exact risk estimate and preferred verbal (52.9% phone/47% in-person) vs. written (26.5% online/19.5% letter) communications. Adjusted regression analyses found that those with a primary family history of breast cancer were significantly more interested in knowing their risk (OR 1.5, 95% CI 1.0, 2.1, p = 0.04), while those categorized as "more than one race or other" were significantly less interested in knowing their risk (OR 0.4, 95% CI 0.2, 0.9, p = 0.02). Women 60 + years of age were significantly less likely to prefer exact estimates of their risk (OR 0.6, 95% CI 0.5, 0.98, p < 0.01), while women with greater than a high school education were significantly more likely to prefer exact risk estimates (OR 2.5, 95% CI 1.5, 4.2, p < 0.001).

CONCLUSION

U.S. women in this study expressed strong interest in knowing their risk and preferred to receive exact risk estimates verbally if found to be at high risk. Sociodemographic and family history influenced women's interest and preferences for risk communication. Breast imaging centers implementing risk assessment should consider strategies tailored to women's preferences to increase interest in risk estimates and improve risk communication.

Gold Nanoparticles Downregulate IL-6 Expression/Production by Upregulating microRNA-26a-5p and Deactivating the RelA and NF-κBp50 Transcription Pathways in Activated Breast Cancer Cells

MicroRNAs (miRNAs) are involved in the modulation of pathogenic genes by binding to their mRNA sequences' 3' untranslated regions (3'UTR). Interleukin-6 (IL-6) is known to promote cancer progression and treatment resistance. In this study, we aimed to explore the therapeutic effects of gold nanoparticles (GNP) against IL-6 overexpression and the modulation of miRNA-26a-5p in breast cancer (BC) cells. GNP were synthesized using the trisodium citrate method and characterized through UV-Vis spectroscopy, dynamic light scattering (DLS), and transmission electron microscopy (TEM). To predict the binding of miR-26a-5p in the IL-6 mRNA's 3'UTR, we utilized bioinformatics algorithms. Luciferase reporter clone assays and anti-miRNA-26a-5p transfection were employed to validate the binding of miR26a-5p in the IL-6 mRNA's 3'UTR. The activity of RelA and NF-κBp50 was assessed and confirmed using Bay 11-7082. The synthesized GNP were spherical with a mean size of 28.3 nm, exhibiting high stability, and were suitable for BC cell treatment. We found that miR-26a-5p directly regulated IL-6 overexpression in MCF-7 cells activated with PMA. Treatment of MCF-7 cells with GNP resulted in the inhibition of IL-6 overexpression and secretion through the increase of miR26a-5p. Furthermore, GNP deactivated NF-κBp65/NF-κBp50 transcription activity. The newly engineered GNP demonstrated safety and showed promise as a therapeutic approach for reducing IL-6 overexpression. The GNP suppressed IL-6 overexpression and secretion by deactivating NF-κBp65/NF-κBp50 transcription activity and upregulating miR-26a-5p expression in activated BC cells. These findings suggest that GNP have potential as a therapeutic intervention for BC by targeting IL-6 expression and associated pathways.

Implications of Agile Values in Software Engineering for Agility in Breast Cancer Treatment: Protocol for a Comparative Study

BACKGROUND

Breast cancer treatment has been described as a dynamic and patient-centered approach that emphasizes adaptability and flexibility throughout the treatment process. Breast cancer is complex, with varying subtypes and stages, making it important to tailor treatment plans to each patient's unique circumstances. Breast cancer treatment delivery relies on a multidisciplinary team of health care professionals who collaborate to provide personalized care and quick adaptation to changing conditions to optimize outcomes while minimizing side effects and maintaining the patient's quality of life. However, agility in breast cancer treatment has not been defined according to common agile values and described in language comprehensible to breast cancer professionals. In the rapidly evolving landscape of breast cancer treatment, the incorporation of agile values from software engineering promises to enhance patient care.

OBJECTIVE

Our objective is to propose agile values for breast cancer treatment adopted and adapted from software engineering. We also aim to validate how these values conform to the concept of agility in the breast cancer context through referencing past work.

METHODS

We applied a structured research methodology to identify and validate 4 agile values for breast cancer treatment. In the elicitation phase, through 2 interviews, we identified 4 agile values and described them in language that resonates with breast cancer treatment professionals. The values were then validated by a domain expert and discussed in the context of supporting work from the literature. Final validation entailed a domain expert conducting a walkthrough of the 4 identified agile values to adjust them as per the reported literature.

RESULTS

Four agile values were identified for breast cancer treatment, and among them, we validated 3 that conformed to the concept of agility. The fourth value, documentation and the quality of documentation, is vital for breast cancer treatment planning and management. This does not conform to agility. However, its nonagility is vital for the agility of the other values. None of the identified agile values were validated as partially conforming to the concept of agility.

CONCLUSIONS

This work makes a novel contribution to knowledge in identifying the first set of agile values in breast cancer treatment through multidisciplinary research. Three of these values were evaluated as conforming to the concept of agility, and although 1 value did not meet the concept of agility, it enhanced the agility of the other values. It is anticipated that these 4 agile values can drive oncology practice, strategies, policies, protocols, and procedures to enhance delivery of care. Moreover, the identified values contribute to identifying quality assurance and control practices to assess the concept of agility in oncology practice and breast cancer treatment and adjust corresponding actions. We conclude that breast cancer treatment agile values are not limited to 4.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/53124.

A Framework for Developing Health Equity Initiatives in Radiology

PURPOSE

In recent years, radiology departments have increasingly recognized the extent of health care disparities related to imaging and image-guided interventions. The goal of this article is to provide a framework for developing a health equity initiative in radiology and to articulate key defining factors.

METHODS

This article leverages the experience of three academic radiology departments and explores key principles that emerged when observing the experiences of these departments that have begun to engage in health equity-focused work.

RESULTS

A four-component framework is described for a health equity initiative in radiology consisting of (1) environmental scan and blueprint, (2) design and implementation, (3) initiative evaluation, and (4) community engagement. Key facilitators include a comprehensive environmental scan, early stakeholder engagement and consensus building, implementation science design thinking, and multitiered community engagement.

CONCLUSIONS

All radiology organizations should strive to develop, pilot, and evaluate novel initiatives that promote equitable access to high-quality imaging services. Establishing systems for high-quality data collection is critical to success. An implementation science approach provides a robust framework for developing and testing novel health equity initiatives in radiology. Community engagement is critical at all stages of the health equity initiative time line.